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DCIS is not Cancer

Posted 10/5/2016

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  There are strong feelings about this one. DCIS (ductal carcinoma in situ) is a diagnosis that has become much more common since mammograms have become standard practice. It has been suggested that almost all women develop DCIS at some point in their lives, and, before mammography, most of the time, it was never detected and never a problem. Yes, some DCIS moves on and becomes invasive cancer, but lots does not.

  It has always been my experience that women who are diagnosed with DCIS are just as distressed and anxious and sad as those who receive a diagnosis of invasive breast cancer. After all, cancer is part of its' name, and understanding the distinction requires some clear-headed sophistication and thinking. That can be hard to come by in the throes of a diagnosis.

  It is also puzzling that DCIS, if it isn't cancer, is still treated like some cancers. In the early years of my career, women with DCIS were routinely treated with a mastectomy while women with early invasive breast cancers frequently had a wide excision/lumpectomy and radiation. How do you explain that one? No, it's not really cancer, but you need a mastectomy????? For a long time now, DCIS has often been treated with smaller surgery and radiation, but there are times when mastectomy is still necessary. If the DCIS is diffuse throughout the breast, it is usually recommended that the whole breast be removed.

  The core problem, as I understand it, is that we are still unable to differentiate DCIS that is going to become invasive cancer from DCIS that is just going to sit there for the rest of a woman's life. In the absence of that critical piece of information, the only choice is to get it out. It is increasingly clear, however, that just as every invasive breast cancer is different from any other, so is DCIS. Treatments need to be individualized and carefully considered.

  From Practice Update comes this information about why DCIS is not really cancer. It is worth reading.

Ductal Carcinoma in Situ Is Not Cancer
September 25, 2016—Chicago—Lesions called ductal carcinoma in situ (DCIS) possess enormous tumor
heterogeneity and varying propensity for progression. They should not all be treated the same, and fail to
meet the accepted definition of cancer.
This assertion was advanced in a talk presented at the 18th Annual Lynn Sage Breast Cancer Symposium,
from September 22 to 25.

Shelley Eun-Sil Hwang, MD, MPH, of Duke University Medical Center, Durham, North Carolina, began by
citing definitions of cancer that DCIS fails to meet:
• Cancer is characterized by uncontrolled cell division, and cell division in DCIS is confined
• Cancer destroys local tissue, and DCIS does not
• Cancer disseminates to distant sites, and DCIS does not
Dr. Hwang stated that common reasons for treating DCIS do not coincide with goals of breast cancer
treatment. DCIS is often treated:
• To detect more DCIS
• To eradicate all microcalcifications
• To alleviate anxiety about breast cancer risk
The goals of treating breast cancer are:
• To reduce breast cancer morbidity
• To eliminate breast cancer mortality

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